Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.005618
Jornal Vascular Brasileiro
Case Report

O impacto da tecnologia no tratamento do trauma vascular iatrogênico cervicotorácico: estudo de dois casos com intervalo de três décadas e revisão da literatura

The impact of technology on treatment of iatrogenic cervicothoracic vascular traumas: a study of two cases three decades apart and a review of the literature

Victor Bilman, Bernardo Massière, Alberto Vescovi, Daniel Leal, Paula Vivas, Bruno Demier, Arno von Ristow

Downloads: 0
Views: 76

Resumo

Complicações relacionadas ao acesso venoso cervicotorácico, como os pseudoaneurismas (PAs), podem ser devastadoras. Neste artigo, apresentamos dois casos semelhantes em que o avanço tecnológico impactou no diagnóstico, tratamento e resultados. Ambos pacientes apresentaram volumoso PA após a tentativa de punção venosa profunda. O primeiro caso, em 1993, diagnosticado por duplex scan, revelou grande PA oriundo da artéria subclávia direita. A artéria foi abordada por esternotomia mediana com extensão supraclavicular. O PA originava-se do tronco tireocervical, tratado com simples ligadura. No segundo caso, em 2017, angiotomografia revelou um PA originário da artéria vertebral, que foi tratado com técnica endovascular, mantendo a perviedade do vaso. Ambos evoluíram satisfatoriamente, apesar de abordagens bastante diferentes. A lesão vascular cervicotorácica representa um desafio propedêutico e terapêutico, com alto risco de ruptura. Os avanços tecnológicos diminuem os riscos de lesões vasculares com acesso cirúrgico difícil e devem estar entre as opções do cirurgião vascular.

Palavras-chave

falso aneurisma; artéria vertebral; cateterismo venoso central; procedimentos endovasculares; stents metálicos autoexpansíveis.

Abstract

Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access.

Keywords

Aneurysm, false; vertebral artery; central venous access; endovascular procedures; self-expanding metallic stents.

References

1. Inamasu J, Guiot BH. Iatrogenic vertebral artery injury. Acta Neurol Scand. 2005;112(6):349-57. http://dx.doi.org/10.1111/j.1600-0404.2005.00497.x. PMid:16281916.

2. Elias M. Pulsating mass in the neck following attempted internal jugular vein catheterisation. Anaesthesia. 1999;54(9):914-5. http://dx.doi.org/10.1046/j.1365-2044.1999.01089.x. PMid:10460719.

3. Bernik TR, Friedman SG, Scher LA, Safa T. Pseudoaneurysm of the subclavian-vertebral artery junction – case report and review of the literature. Vasc Endovascular Surg. 2002;36(6):461-4. http://dx.doi.org/10.1177/153857440203600607. PMid:12476236.

4. Guilbert MC, Elkouri S, Bracco D, et al. Arterial trauma during central venous catheter insertion: case series, review and proposed algorithm. J Vasc Surg. 2008;48(4):918-25. http://dx.doi.org/10.1016/j.jvs.2008.04.046. PMid:18703308.

5. Ambekar S, Sharma M, Smith D, Cuellar H. Successful treatment of iatrogenic vertebral pseudoaneurysm using pipeline embolization device. Case Rep Vasc Med. 2014;2014:341748. http://dx.doi.org/10.1155/2014/341748. PMid:25276469.

6. Yu NR, Eberhardt RT, Menzoian JO, Urick CL, Raffetto JD. Vertebral artery dissection following intravascular catheter placement: a case report and review of the literature. Vasc Med. 2004;9(3):199-203. http://dx.doi.org/10.1191/1358863x04vm565cr. PMid:15675185.

7. Cihangiroglu M, Rahman A, Yildirim H, Burma O, Uysal H. Iatrogenic vertebral artery pseudoaneurysm: US, CT and MRI findings. Eur J Radiol. 2002;43(1):14-8. http://dx.doi.org/10.1016/S0720-048X(01)00451-X. PMid:12065115.

8. Aoki H, Mizobe T, Nozuchi S, Hatanaka T, Tanaka Y. Vertebral artery pseudoaneurysm: a rare complication of internal jugular vein catheterization. Anesth Analg. 1992;75(2):296-8. http://dx.doi.org/10.1213/00000539-199208000-00027. PMid:1632547.

9. Yilmaz MB, Donmez H, Tonge M, Senol S, Tekiner A. Vertebrojugular arteriovenous fistula and pseudoaneurysm formation due to penetrating vertebralartery injury: case report and review of the literature. Turk Neurosurg. 2015;25(1):141-5. PMid:25640560.

10. Amaral JF, Grigoriev VE, Dorfman GS, Carney WI Jr. Vertebral artery pseudoaneurysm. A rare complication of subclavian artery catheterization. Arch Surg. 1990;125(4):546-7. http://dx.doi.org/10.1001/archsurg.1990.01410160134026. PMid:2322123.

11. Perissé RSP, Ristow AV, Palazzo JCC. Traumatismos vasculares da região cérvico-torácica e cervical. In: Ristow AV, Moreira RSP, editors. Urgências vasculares. Rio de Janeiro: Editora Cultura Médica; 1983. p. 76-101.

12. Meirelles SSL, Ristow AV. Trauma dos vasos cervicais. In: Freire E, editor. Trauma. Rio de Janeiro: Atheneu; 2001. p. 1341-1364.

13. Pérez GCI, Morata AR, Ortega JPR, Medialdea RG, García PC. Endovascular Treatment of a Symptomatic Vertebral Artery Pseudoaneurysm. Ann Vasc Surg. 2015;29(5):1018.e5-8. http://dx.doi.org/10.1016/j.avsg.2015.01.022. PMid:25770383.

14. Guan Q, Chen L, Long Y, Xiang Z. Iatrogenic vertebral artery injury during anterior cervical spine surgery. A systematic review. World Neurosurg. 2017;106:715-22. http://dx.doi.org/10.1016/j.wneu.2017.07.027. PMid:28712898.

15. Kerolus M, Tan LA, Chen M. Treatment of a giant vertebral artery pseudoaneurysm secondary to gunshot wound to the neck using pipeline embolization device. Br J Neurosurg. 2016;1-2. http://dx.doi.org/10.1080/02688697.2016.1265087. PMid:27927019.

16. Kwon SH, Oh JH. A large vertebral artery pseudoaneurysm due to percutaneous internal jugular vein cannulation. Intensive Care Med. 2014;40(12):1934. http://dx.doi.org/10.1007/s00134-014-3441-2. PMid:25118869.

17. Yamamoto A, Suzuki K, Sakaida H, Suzuki H, Imai H. Management of inadvertent vertebral artery injury due to central venous catheterization in a coagulopathic patient. Acute Med Surg. 2016;3(3):265-7. http://dx.doi.org/10.1002/ams2.177. PMid:29123795.

18. Aydin E, Gok M, Esenkaya A, Cinar C, Oran I. Endovascular Management of Iatrogenic Vascular Injury in the Craniocervical Region. Turk Neurosurg. 2018;28(1):72-8. PMid:27593845.

19. Abeysinghe V, Xu JH, Sieunarine K. Iatrogenic injury of vertebral artery resulting in stroke after central venous line insertion. BMJ Case Rep. 2017;2017. http://dx.doi.org/10.1136/bcr-2017-222429. PMid:29167220.

5cd183b70e88251515632f8f jvb Articles

J Vasc Bras

Share this page
Page Sections